Epilepsy medicines, contraception and pregnancy

Valproate (sodium valproate, Depakine, Epilim)

Taken in pregnancy, valproate causes birth defects in around 1 in 10 babies, and developmental and learning problems in around 3 to 4 in 10. In the UK and Europe it must not be used by women and girls who could become pregnant unless no other treatment is suitable and a pregnancy prevention programme is in place. If valproate is the medicine that controls your seizures, don’t stop it: ask for a specialist review. In the UK, men taking valproate are also advised to use effective contraception as a precaution.

Topiramate

Topiramate raises the risk of birth defects and of a smaller baby, and may affect development. It should not be used in pregnancy for epilepsy unless there is no other suitable treatment.

Other medicines

Lamotrigine and levetiracetam have the most reassuring pregnancy data among the commonly used medicines. Even so, the right medicine is the one that controls your seizures at the lowest effective dose; changing medicine is best done before pregnancy, slowly, and under supervision. Blood levels of some medicines, especially lamotrigine, fall during pregnancy, so the dose may need adjusting.

Some seizure medicines speed up how the liver breaks down contraceptive hormones. These include carbamazepine, oxcarbazepine, eslicarbazepine, phenytoin, phenobarbital, primidone, perampanel, rufinamide, and topiramate at 200 mg a day or more. With these, the pill, patch, vaginal ring and implant may fail. The copper coil, the hormonal coil and the contraceptive injection are not affected and are usually recommended. The effect lasts about four weeks after stopping one of these medicines.

Lamotrigine works the other way: pills containing oestrogen lower lamotrigine levels, which can bring seizures back. If you take lamotrigine and start or stop such a pill, tell your doctor.

For emergency contraception while taking one of these medicines, a copper coil is the most reliable choice. Tell the pharmacist which seizure medicine you take; the usual emergency pill may need a different dose.

• See your neurologist before you start trying; changes to medicine take months to do safely.
• Start folic acid before pregnancy. Women taking seizure medicines are often prescribed a higher dose than usual; ask which dose is right for you.
• Ask whether you should join a pregnancy register; these collect information that helps future mothers.
• Plan the birth with your team, including what to do if a seizure happens in labour.

Questions you can ask your doctor

Pick the ones that fit, then copy or print them.

1. Is my medicine safe in pregnancy, and is there a safer option for me?
2. Does my medicine affect my contraception? What do you recommend?
3. What dose of folic acid should I take, and from when?
4. Will my dose need to change during pregnancy?
5. Can I breastfeed on my medicine?

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Copy questionsPrint for your appointment

Most women taking seizure medicines can breastfeed; ask your team about your particular medicine. If your dose was raised in pregnancy, it may need lowering after the birth. Broken sleep is a strong trigger, so share night feeds where you can. Change and dress the baby on the floor, bathe the baby only with another adult present, and use a pram rather than carrying the baby on stairs if your seizures aren’t controlled.